Pharm Test 4 Marian University Nursing Program 2016 – Flashcards
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Respiratory Disorders
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Asthma - NAEPP - reversible shortness of breath, airways narrow, bronchospasm, inflammation & edema and production of mucus Chronic Obstructive Pulmonary Disease - 50% do not adhere to treatment Chronic Bronchitis Emphysema Drug Therapy Plans 1. Long term Prevention 2. Relief or rescue with acute attacks
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Bronchodilators
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Stimulate beta 2 - causes bronchiodialation albuterol (Proventil) - inhaled, first choice, can't use too much epinephrine (Adrenalin) - given sq, mostly given in ER during significant salmeterol (Serevent) - give 2 x day, for asthma and COPD, maintenance drug.
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Bronchodilators Use
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asthma
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Bronchodilators Adverse
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?HR, and force of contraction
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Bronchodilators Contraindications
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cardiac tachyarrythmias, severe CAD, HTN, DM
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Bronchodilators Nursing Implications
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Teach prevention Use of inhaler Wait 3-5 minutes between puffs Rinse mouth May use spacer Bronchodilator first then other inhaler Mark rescue inhaler for easy ID
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Anticholinergics
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Block action of acetylcholine in bronchial smooth muscle ipratropium (Atrovert) - not for rescue tiotropium (Spiriva) - same
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Anticholinergics Use
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maintenance therapy for bronchitis/emphysema
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Anticholinergics Adverse
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nervousness, HA, hypotension, GI distress
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Corticosteroids
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Suppress inflammation, ?mucous production, ? edema fluticasone (Flonase) beclomethasone (Beclovent) budesonide (Pulmicort) triamcinolone (Azmacort) dexamethasone (Decadron) methylpredisone (IV), prednisone (po)
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Corticosteroids Adverse
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inhaled avoids systemic problems, impaired growth in children, dry mouth, cough
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Corticosteroids Nursing Implications
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Usually not given in acute attack May be given alone or w/bronchodilator Use corticosteroid inhaler last Gargle after use
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Mixed Drugs
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Ipratropium/albuterol (Combivent, DuoNeb) Anticholinegic and short term beta 2 Fluticasone/salmeterol (Advair) Inhaled steroid and long acting beta 2 Combination drugs for maintenance - NOT rescue
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Xanthines
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Causes bronchodilation theophylline (Theo-dur, Aminophylline) Not first line agent Therapeutic level 5-15mcg/mL
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Xanthines Adverse
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CNS stimulation, ?cardiac output, restlessness, convulsions, tachycardia
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Xanthines Toxicity
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seizures, arrhythmias
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Leukotriene Modifiers
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Leukotrienes cause bronchoconstriction and inflammation zafirlukast (Accolate) montelukast (Singulair)
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Leukotriene Use
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asthma along w/ bronchodilators and steroids
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Leukotriene Adverse
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N/V, H/A, infection
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Leukotriene Contraindications
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liver disease Used for prevention only
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Antihistamines
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Antagonize the action of histamine by occupying receptor sites diphenhydramine (Benadryl) - 1st generation problems with drowsiness fexofenadrine (Allegra) - 2nd generation loratadine (Claritan) - 2nd generation
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Antihistamines Uses
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Seasonal allergic rhinitis
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Antihistamines Nursing
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safety, give w/ food, for seasonal - take regularly
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Nasal decongestants
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Shrink engorged nasal mucosa pseudoephedrine (Sudafed) oxymetazoline (Afrin) phenylephrine (NeoSynephrine)
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Nasal decongestants Uses
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Relieves nasal congestion
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Nasal decongestants Adverse
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Contraindicated w/ severe HTN, CAD
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Antitussives
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Suppress cough center in the medulla Opioid and non-opioid Non narcotic: dextromethorphan (Benylin) Narcotic: codeine or hydrocodone added to syrup
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Antitussives Uses
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relieve dry hacking cough
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Antitussives Adverse
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Dizziness, sedation, nausea
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Expectorants
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Relief of a productive cough guaifenesin (Mucinex, Robitussin)
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Expectorants Uses
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Thins respiratory secretions Can be combined in cold remedy formula Take only as needed
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Antacids
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Alkaline substances that neutralize stomach acids Aluminum, magnesium, calcium Available OTC
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Antacids Adverse
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Magnesium - diarrhea Aluminum - constipation Calcium - intestinal gas, constipation acid rebound
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Antacids Nursing implications
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Mg++ not given w/ renal insufficiency Interferes w/ many drugs by binding in the GI tract Mg++ - acts rapidly, highly neutralizing, long duration Assess pain Ca+ most effective for heart burn Check sugar content for diabetics Give 1-3 hours after meals and at bedtime
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Histamine-2 receptor antagonist
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Suppress the secretion of gastric acid and ? pepsin in stomach famotidine (Pepcid) ranitidine (Zantac) cimetidine (Tagamet) - prototype likely to cause drug interactions
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Histamine-2 receptor antagonist Uses
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tx peptic ulcers, GERD, stress ulcers Po or IV
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Proton pump inhibitors
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Inhibits gastric acid secretions. Prevent pumping of gastric acid from parietal cells omeprazole (Prilosec) - prototype lansoprazole (Prevacid) pantoprazole (Protonix) - IV
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Proton pump inhibitors Use
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erosive gastritis, symptomatic GERD, ulcers, stress ulcer prophylaxis, H pylori
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Proton pump inhibitors Nursing
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heal in 4-8 weeks, swallow whole, give most before food
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Helicobacter pylori agents
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Many GI ulcers caused by H. Pylori bacteria Multiple drugs used to heal ulcers 2 antimicrobials (amoxicillin, clarithromycin, metronidazole, tetracycline) + 1 proton pump inhibitor and/or 1 histamine 2 receptor antagonist
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misoprostol (Cytotec)
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Synthetic prostaglandin given w/ NSAIDs to protect gastric mucosa
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sucralfate (Carafate)
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Acts locally to protect gastric mucosa
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Laxatives and cathartics
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Laxatives - mild effect to eliminate soft formed stool Cathartics - strong effect to eliminate loose stool
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Laxatives and cathartics Use
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relieve constipation, prevent straining, empty bowel, eliminate toxic substances
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Laxatives and cathartics Use Contraindications
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undiagnosed abdominal pain, intestinal obstruction
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psyllium (Metamucil)
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Bulk forming laxative - long term
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docusate sodium (Colace)
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Surfactant laxative - prevent straining - only softens stool, does not cause deification
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magnesium citrate
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Saline cathartics - bowel prep
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bisacodyl (Dulcolax) - glycerine suppositories
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Stimulant cathartics
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Mineral oil
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Lubricant laxatives - to soften hard dry feces
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Laxatives and cathartics Adverse
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Impaction Abuse ? fluids ? fiber
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Antidiarrheals
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Opiates loperamide (Imodium) diphenoxylate (Lomotil)
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Metamucil
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Bulk Forming
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Pepto- Bismol
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Bismuth salts
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Antiemetics
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Prevent/treat nausea/vomiting Serotonin blockers ondansetron (Zofran) - used for chemo ; post op, not given to preg. d/t fetal heart malformations and cleft lip Prokinetic agent metoclopramide (Reglan) - delays gastric emptying, used for reflux and antiemetic, EPS symptoms Phenothiazines promethazine (Phenergan) prochlorperazine (Compazine)
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Syrup of Ipecac
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Emetics
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Drugs to treat obesity
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Fat blocker orlistat (Xenical)
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Drugs for weight gain
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megestrol (Megace)
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Vitamins
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Organic compounds essential for energy transformation and regulation of metabolic processes Fat vs Water soluble vitamins RDA - recommended daily allowance
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Vitamins Cont..
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Drugs that effect absorption - laxatives/antibiotics - ?fat soluble absorption
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Vitamin Nursing Implications
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Warn against mega doses Administer separate from laxatives No evidence that "natural" are more superior to synthetic Eat a well balanced diet
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Mineral and Electrolytes
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Essential to bone, teeth, cell membrane connective tissue and enzymes Varied well balanced diet provides enough minerals for most
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Iron
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Used to prevent or treat iron deficiency anemia ferrous sulfate (Feosol) iron dextran injection (InFeD), IV
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Iron Nursing Implications
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Take before meals or after and full glass H2O Warn GI upset, black stools Take liquid w/ straw
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Potassium
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K+ and Cl- deficiencies often occur together potassium chloride (KCL)
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Potassium Use
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replacement for use w/ diuretic, poor diet, GI losses Po or IV
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Nursing implications:
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IV dose diluted and given slowly over 2-3 hrs, took quick can kill pt PO dose mixed w/ at least 4oz fluid Best absorbed on empty stomach
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Hyperkalemia
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Cation exchange resin - acts in colon to release Na and combines with K to eliminate in stool Na+ polystyrene sulfonate (Kayexalate)
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Hyperkalemia Use
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Oral or rectal Acts in colon to release Na+ and combine w/ K+ and eliminated in feces
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Hyperkalemia Nursing implications
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Stop all forms of K+ Cardiac monitoring Each Gm of resin will K+ approx 1 mEq Retain enema for 1 hour May need dialysis Also may use IV regular insulin and D50
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Magnesium
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Given for low Mg++ levels magnesium oxide po magnesium sulfate IM or IV
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Magnesium Use
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control convulsions associated w/ eclampsia
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Estrogens
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Synthetic estrogen, block the follicle stimulating hormone and luteinizing hormone Conjugated estrogen (Premarin) - po, patch
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Estrogen Use
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component in birth control, menopause, endometriosis, replacement therapy for deficiency states, post coital, emergency contraception, also must use Progesterone if woman still has uterus
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Estrogen Adverse effects:
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?risk of thrombophlebitis, pulmonary embolism, coronary thrombosis. Use associated w/ endometrial cancer, thromboembolic events, risk of dementia and risk of breast cancer.
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Estrogen Contraindicated
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pregnancy, thromboembolic disorders, breast cancer, smoking
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Progestins
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Act on endometrial lining, suppress ovulation, inhibit uterine contractions. Medroxyprogesterone (Provera, Depo Provera)
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Progestins Use
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part of combination product w/ estrogen, dysmenorrhea, endometriosis, endometrial cancer, uterine bleeding.
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Estrogen-Progestin combinations
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Estrogen component suppresses FSH and LH, progestin thins the endometrium, slows sperm transport and thickens cervical mucus Ortho Tri-Cyclen Yaz Loestrin NuvaRing - intravaginal ring Prempro for HRT
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Estrogen-Progestin Use
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primary -birth control, also tx acne, premenstrual dysphoric disorder (Yaz)
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Estrogen-Progestin Contraindications
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smoking, ;35 years, HTN, migraines w/aura, inc K+ (Yaz)
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Estrogen-Progestin Nursing Implications
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Caution women over 35 who smoke Many side effects Many interactions w/ other drugs Educate against possible stroke, blood clots Missed dose may result in pregnancy Stop taking med if become pregnant Possible weight gain Does not prevent STDs Monitor BP
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Ovulation Stimulants
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Same effects as natural hormones, enhance or enable reproduction clomiphene (Clomid)
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Ovulation Stimulants Use
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treat infertility
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Ovulation Stimulants Adverse Effects
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DVT, ovarian hyperstimulation, multiple pregnancies, hot flashes, breast pain
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Tocolytics
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given to inhibit labor and maintain pregnancy before 37 weeks (preterm labor)
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Magnesium sulfate
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Pre-eclampsia, eclampsia
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Nifedipine (Procardia)
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Calcium channel blocker that ?s contractions and lowers BP Use - controversial
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Terbutaline sulfate (Brethine)
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Inhibits uterine contractions Adverse: palpitations, hyperkalemia, hyperglycemia. Crosses placenta
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dinoprostone (Cervidil)
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Use - promote cervical ripening Gel, vaginal suppos Cervical ripening Not for use w/ women ;30years causes DIC
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oxytocin (Pitocin)
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promotes uterine contractility, can stop bleeding postpartum
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Prostaglandins Use
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Promote uterine contractility to expel fetus, ?uterine bleeding post partum
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Prostaglandins Adverse:
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HTN, cardiac dysrhythmias
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Androgens
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testosterone (Depo-Testosterone) Maintain muscular and skeletal proteins
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Androgens Use
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Used in delayed puberty, deficiency states Given IM, transdermal Not for body building
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PDE5 inhibitors
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Improvement in erectile dysfunction sildenafil (Viagra) Only Take 1 x day, painful erection
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Viagra Adverse
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HA, flushing, dizziness Do not take w/ NTG Only take once a day
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BPH Drugs (Benign prostatic hyperplasia)
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5-alpha reductase inhibitors finasteride (Proscar) Can cause sexual dysfunction - usually transient Pregnant nurses should not handled crushed drug - adverse effects for male fetus Max benefit 6-12months
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BPH Drugs (Benign prostatic hyperplasia)
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Alpha1 blockers tamsulosin (Flomax) Adverse: hypotension Take same time every day
